You and your peers have been either slowly getting your Medicare payments or not getting them at all since the industry switch to HIPAA 5010 on Jan. 1. While it’s been confirmed that your payments are in a virtual limbo between clearinghouses and payers, there are numerous reasons why your claims are getting “lost.”

You must have a clear plan of action before you drop a payer after a bout of bad contract negotiations. There are key preparatory steps you must take to ensure your practice can thrive after the split, experts tell Part B News.

Carefully and cautiously bill consult codes to private payers and Medicare Advantage plans so you’ll reap the benefits of increased revenue and avoid denials. Remember: While a growing number of private payers have also eliminated consults, many still allow and pay for consult codes.

CMS hasn’t forgotten about it’s promise to update the Provider Enrollment Chain Ownership System (PECOS) website with a user-friendly “fast-track” feature (PBN 9/26/11). The feature is now available on the PECOS website.

This chart examines how practices incorporate patient satisfaction survey results into their workflow. The data, which comes from the Medical Group Management Association’s (MGMA) Performances and Practices of Successful Medical Groups: 2011 Report based on 2010 data, measures the utilization rates of 11 different options a practice has in using its patient satisfaction results.

Is it correct to bill 63707(repair of dural/cerebrospinal fluid leak, not requiring laminectomy) or 63709 (repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy) with modifier 59 (distinct procedural service) if a neurosurgeon breaches dura mater in the brain or spine during surgery?

You may be missing out on extra Medicare reimbursements for new preventive services simply because your physicians still don’t realize – two months into 2012 – that their non-physician practitioners (NPPs) can assume the majority of the workflow.

You and your peers lose tens of millions of dollars in incident-to service denials due to improper physician supervision. The crux of NPP billing regardless of whether it’s incident-to or not lay with proper supervision. Review each types of supervision and each scenario detailing where a doctor must be physically for an NPP to render specific services.

This chart, from the 2010 American Academy of Physician Assistants Census, represents the annual median compensation for physician assistants (PAs) broken down by seven specialty types. NOTE: Survey data was collected between October 2010 and April 2011 and represents nearly 20,000 clinically practicing PAs, or almost a quarter of the total PA workforce. 

Can dietitians and nutritionists bill services “incident-to” if they operate out of a physician practice? If so, can the nutritionist bill under the physician that is onsite that day and is different than the patient’s primary care provider for the new obesity counseling service? Also, what services can the dietitians bill “incident-to” and what supporting documentation is needed?